美国东部时间10月8日，世界顶级医学期刊《新英格兰医学杂志》（影响因子：IF = 74.699）发表题为《死于领导力真空》的编辑设评论文章，号召选民把特朗普政府选下台，这一举动也是该期刊史无前例的介入美国大选政治行为，表现出了美国学术界对美国现任政府领导力极度失败的一种绝望心态。小编把该文中英双语给大家转载如下：

Dying in a Leadership Vacuum

死于领导力真空

Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.

The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly.

We know that we could have done better. China, faced with the first outbreak, chose strict quarantine and isolation after an initial delay. These measures were severe but effective, essentially eliminating transmission at the point where the outbreak began and reducing the death rate to a reported 3 per million, as compared with more than 500 per million in the United States. Countries that had far more exchange with China, such as Singapore and South Korea, began intensive testing early, along with aggressive contact tracing and appropriate isolation, and have had relatively small outbreaks. And New Zealand has used these same measures, together with its geographic advantages, to come close to eliminating the disease, something that has allowed that country to limit the time of closure and to largely reopen society to a prepandemic level. In general, not only have many democracies done better than the United States, but they have also outperformed us by orders of magnitude.

我们知道我们本可以做得更好。中国面对第一次爆发的疫情，虽然在最初有所延搁，但是选择了严格的检疫和隔离。这些措施虽然严厉，但却很有效，基本上在疫情开始的地方就杜绝了传播，并将死亡率降至报道的百万分之三，而美国的死亡率为百万分之五百。而那些与中国有更多交流的国家，如新加坡和韩国，很早就开始了密集的检测，同时还进行了积极的接触者追踪和适当的隔离，疫情相对较小。而新西兰也利用这些措施，加上地理优势，接近消灭了这种疾病，这让新西兰缩短了封闭时间，社会基本重新开放到流行前的水平。总的来说，许多民主国家不仅做得比美国好，而且它们的表现也比我们好几个数量级。

Why has the United States handled this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. And we continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have.2 Moreover, a lack of emphasis on developing capacity has meant that U.S. test results are often long delayed, rendering the results useless for disease control.

Although we tend to focus on technology, most of the interventions that have large effects are not complicated. The United States instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don’t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures. The government has appropriately invested heavily in vaccine development, but its rhetoric has politicized the development process and led to growing public distrust.

虽然我们倾向于关注技术，但大多数有效的干预并不复杂。美国在许多社区大量传播之后，才迟迟地、不一致地制定了检疫和隔离措施，而且往往没有努力去执行。在许多地方，我们关于社会隔离的规则也是乏善可陈的，在疾病得到充分控制之前很长时间就放松了限制。而在美国的很多地方，人们根本就不戴口罩，这主要是因为我们的领导人直言口罩是政治工具，而不是有效的感染控制措施。政府在疫苗研发上适当地投入了大量资金，但其言辞却将研发过程政治化，导致公众的不信任感越来越强。

The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.

美国带着巨大的优势进入这场危机。除了强大的生产能力，我们还有一个令全世界羡慕的生物医学研究体系。我们在公共卫生、卫生政策和基础生物学方面拥有大量的专业知识，并且一直能够将这些专业知识转化为新的疗法和预防措施。而这些国家的专业知识大部分都掌握在政府机构手中。然而，我们的领导人在很大程度上选择了忽视甚至诋毁专家。

The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized,3 appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

我们国家领导人的反应一直不够充分。联邦政府已经在很大程度上把疾病控制交给了各州。州长们的反应各不相同，与其说是党派不同，不如说是能力不同。但无论他们的能力如何，州长们都没有华盛顿所控制的工具。联邦政府不但没有使用这些工具，反而破坏了它们。美国疾病控制和预防中心曾是世界上最主要的疾病应对组织，但现在已经被削弱，其测试和政策失败可算得上戏剧性。美国国家卫生研究院在疫苗研发中发挥了关键作用，但在很多关键的政府决策中却被排除在外。食品和药物管理局被可耻地政治化了，似乎是为了应对来自政府的压力而不是科学证据。我们现在的领导人破坏了对科学和政府的信任，造成的损害肯定会比他们更久。政府没有依靠专业知识，而是转而求助于无知的“意见领袖”和骗子，他们掩盖真相，助长谎言。

Let’s be clear about the cost of not taking even simple measures. An outbreak that has disproportionately affected communities of color has exacerbated the tensions associated with inequality. Many of our children are missing school at critical times in their social and intellectual development. The hard work of health care professionals, who have put their lives on the line, has not been used wisely. Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of hundreds of billions of dollars and millions of jobs. And more than 200,000 Americans have died. Some deaths from Covid-19 were unavoidable. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II.

让我们明确一下不采取哪怕是简单措施的代价。疫情的爆发对有色人种社区的影响尤为严重，加剧了与平等有关的紧张局势。我们的许多儿童在其社会和智力发展的关键时期缺课。冒着生命危险的保健专业人员的辛勤工作没有得到明智的利用。我们目前的领导层对经济感到自豪，但尽管世界上大多数国家在某种程度上开放了，美国仍然饱受疾病的困扰，使许多企业无法重新开业，结果损失了数千亿美元和数百万个工作岗位。而且已经有20多万美国人死亡。Covid-19造成的一些死亡是不可避免的。但是，虽然不可能推算出因为政府政策软弱和不当而导致的额外美国人生命损失的确切数字，但估计至少有数万人，这已经比二战以来任何一场冲突中死亡的美国人都多。

Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.

其他任何人以这种方式鲁莽地挥霍生命和金钱，都会承受法律后果。我们的领导人在很大程度上声称他们的行为可以豁免。但这次选举给了我们做出判断的权力。理性的人肯定会对候选人采取的许多政治立场产生分歧。但真理既不是自由派，也不是保守派。在应对我们这个时代最大的公共卫生危机时，我们目前的政治领导人已经表明，他们是危险的无能者。我们不应该支持他们，让他们保住工作，从而导致成千上万的美国人死亡。

文章来源：https://www.nejm.org/doi/full/10.1056/NEJMe2029812